P.E.T. NEWS
Number 6 Autumn 2003
Weatherhead
WeatherheadP.E.T.
P.E.T.Center
Centerfor
forPreventing
Preventingand
andReversing
ReversingAtherosclerosis
Atherosclerosis
The
University
of
Texas-Houston
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and
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The University of Texas-Houston Medical School and MemorialHermann
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Heart News
Medicare Approves Payment for
Some PET Scans
The Weatherhead PET Imaging Center is pleased to announce that after
years of planning and negotiations, PET Imaging of the
heart has finally been recognized by the Health Care
Financing Administration for reimbursement in outpatients with established heart disease on Medicare. The
staff of the Center has spent the last year obtaining approval as a Medicare provider, learning the rules and
setting up the complicated processes for Medicare billing. Since private insurance carriers usually follow the
guidelines set up by HCFA, other insurance reimbursement may become available for PET.
Unfortunately, Medicare’s recent reimbursement approval does not include patients with only the risk factors for heart disease including family history, high cholesterol levels, high blood pressure, or chest pain. These
patients will have to continue to pay out of pocket for
PET unless the PET scan establishes a diagnosis of
coronary artery disease since Medicare coverage is only
available in patients with an established diagnosis of
coronary atherosclerosis. Non-Medicare patients will
have to accept whatever their private insurance will reimburse.
Medicare coverage for PET acknowledges the importance of PET in the evaluation and management of heart
disease patients. The coverage makes this important
technology available to many people over the age of 65
who otherwise would not be able to afford it. However,
as this shift to third party reimbursement takes place, it
brings with it some necessary changes in our operational
procedures.
In order to accommodate a higher volume of patients,
Dr. Stefano Sdringola will become more active in performing and interpreting PET scans; also we have developed a more streamlined level of service for referring
continued on page 2 . . .
New Website
The Weatherhead PET
Imaging Center is pleased to
announce it’s new website:
www.healyourheart.info
It should serve as an additional place for information and updates from the PET
Center.
Other helpful Nutrition and Exercise Websites:
www.nutritiondata.com helps you calculate the calories
in your favorite recipes and has nutrition data on Fast
Food items.
www.caloriesperhour.com helps you figure how many
calories you burn with different activities
www.dietpower.com helps calculate calories in home
recipes
http://147.208.9.133/ helps you record daily meals and
calculate the nutritional value.
One of America’s Top Doctors
A popular consumer guide to the nation’s most outstanding physicians has chosen 18 full-time faculty members
from The University of Texas Medical School at Houston,
as well as the institution’s president, James T. Willerson
M.D. to be included as America’s Top Doctors. The 2003
edition of America’s Top Doctors includes less than 1 percent of U.S. physicians.
For the second year in a row, K. Lance Gould, M.D. is
listed as one of the top Doctors in America in Cardiology.
Only physicians nominated and reviewed by their medical peers are eligible for recognition in America’s Top
Doctors. Evaluators based their assessment of these “top
docs” on the individual’s rigorous medical training, extensive clinical knowledge and experience, and further training in some specialties. These outstanding physicians
meet not only these stringent general criteria, but also
possess unique skills in their field.
Medicare continued . . .
physicians. The new color-coded pricing plan differentiates our levels of service and can be reviewed on our
web site www.healyourheart.info. This plan provides the
highest quality PET imaging of the heart at an affordable
price, yet still offers the expertise of K. Lance Gould M.D.
for follow-up preventive care.
As we incorporate these changes and continue to evolve,
the primary mission of the Weatherhead PET Imaging
Center remains the same. We will continue to be a
unique, state of the art Imaging Center dedicated to the
Prevention and Reversal of Heart Disease by combining
the most advanced scientific technology and principles
with individualized personal care.
The significance of C-reactive Protein
Several recent large studies have identified the C-reactive Protein (CRP), a marker for inflammation in the body,
as an important predictor of heart attacks and strokes.
These reports have stimulated lots of questions about
who should have this simple blood test.
The CRP is a non-specific marker of inflammation in the
body. It can be elevated with any inflammatory process
in the body including an infection, injury, or arthritis that is
not necessarily related to the heart or blood vessels.
Secondly, although inflammation has been shown to be
partly responsible for plaque rupture, there is no evidence
that normalizing CRP alone will improve outcomes or save
lives in heart disease. Furthermore, there is no specific
treatment for lowering CRP other than treating the basic
disease as we do with lifestyle and medications which
also then prevents heart attacks and lowers CRP.
Asking for a CRP test makes sense if you feel you need
an added incentive to work on the standard risk factors
for heart disease, excess weight, high blood pressure,
high cholesterol, smoking or diabetes. An elevated CRP
reading (3mg/liter or higher) might also be the deciding
factor for drug treatment when cholesterol levels are borderline.
We have not measured CRP routinely in Dr. Gould’s program since our usual guidelines include the most intense
comprehensive treatment possible that reduces CRP and
inflammation anyway. Our integrated program of daily
aspirin, statins or other lipid lowering drugs, low fat food,
exercise and weight loss stabilizes or partially reverses
vascular disease, markedly reduces the risk of heart attack, improves heart blood flow and also reduces CRP
levels.
Corner Pharmacy
Anticoagulation Therapy
This article will review the risks
and benefits of warfarin, better
known by its brand name,
Coumadin, a common medication used to treat patients
with heart disease. Coumadin is a strong anticoagulant
medication that prevents blood clots by inhibiting the
synthesis of Vitamin K dependent blood clotting factors.
Discovered in the 1940s, Coumadin was first used to prevent blood clots in patients after having a heart attack.
President Eisenhower received the drug after his heart
attack in 1954. Concern about its safety and side effects
of bleeding reduced the drugs popularity for a number of
years until the late1980s when studies were published
that established a clear benefit and safety for using the
drug for certain medical conditions.
Today, Coumadin is used routinely in patients with a heart
rhythm problem called atrial fibrillation to prevent stroke
and in patients who receive mechanical heart valve replacements to prevent blood clot formation in the valve.
Coumadin is also used to treat blood clots in the legs and
to prevent clot formation in patients who have had a large
heart attack.
Because of the potential side effect of bleeding, careful
monitoring of the blood clotting ability must be done in
patients taking Coumadin. A blood test called the Prothrombin time/INR must be done at least every 4-6 weeks
or more frequently if the dosage is being adjusted. Patients should monitor themselves for any sign of excess
bruising and bleeding such as bleeding gums, nosebleeds, or blood in the urine or stool and should report
these symptoms immediately.
Leafy green vegetables and salads have high content of
vitamin K that counteracts the effects of Coumadin. Therefore, some Coumadin directions warn against eating such
foods. However, this advice to avoid green leafy vegetables is not correct since such foods are an important
part of a heart healthy diet. The important point is to eat
green leafy vegetables and salads daily as a steady habit
and adjust the dose of Coumadin slightly higher to achieve
the correct goals of the prothrombin time/INR. It is important such foods be continued daily since stopping them
will result in greater effect of the Coumadin that could
potentially lead to an increased risk of bleeding. On the
other hand, if the Coumadin dose were adjusted for a
diet without green leafy vegetable foods, then eating such
foods would reduce the effect of the Coumadin and blood
continued on page 4 . . . .
Heart Star
On the advice of his brother, Bob Casson came for
a PET scan instead of arriving for his scheduled
Coronary Artery Bypass Surgery. He wanted a second opinion; things were moving too quickly. Four
episodes of feeling slightly short of breath and anxious had led Bob to get a physical exam at his
doctor’s office. A treadmill test was positive at that
time and a further nuclear stress test was positive
as well. A week later, cardiac catheterization was
carried out and Mr. Casson was told he needed
Coronary Artery Bypass Surgery in two days for a
90% blockage in one artery.
Unfortunately, like many patients Bob Casson had
just been introduced to the standardized “Cardiac
assembly line” treatment plan that is available in
most medical facilities. But he stepped off. He
wanted to be sure that the surgery was absolutely
necessary, and wanted to know if alternative treatments were available for his individual case. After
sitting down to discuss his PET scan results with
Dr. Gould, Mr. Casson knew he was in the right
place.
The PET scan results indicated that the blockages
in Mr. Casson’s arteries were not severe enough to
limit the blood flow to his heart during stress conditions. This made it very unlikely that one of his arteries was 90% blocked. Further analysis of his
angiogram film revealed that he had diffuse mild
blockages in several arteries but the most severe
was 50-60%. This case exemplifies many of the
problems with conventional cardiac care. Inaccurate visual estimates of narrowings on coronary
arteriograms frequently lead to invasive procedures
and surgery. These revascularization procedures are commonly done as the primary therapy for coronary heart disease,
although studies show no improvement in long-term survival with bypass surgery when compared to medical treatment.
On the other hand, over 30 large well-done, published scientific studies have confirmed that cholesterol lowering substantially reduces heart attacks and the need for bypass surgery and balloon dilation. The added benefit and importance
of other lifestyle changes such as diet and exercise have also been confirmed.
Under Dr. Gould’s direction, Bob Casson became serious about his lifestyle. “I needed Dr. Gould’s stern direction to help
me pay attention to my life,” says Casson. He was started on one medication for his high cholesterol and another
specifically for his high triglyceride level. His LDL (bad cholesterol) went from 164 down to 70. Through better diet and
blood pressure medications, his symptoms which had actually been caused by high blood pressure, were soon relieved.
Four years later, Bob continues the lifestyle changes he learned through the Weatherhead PET Imaging Program for
Reversal of Heart Disease. At 56, he feels good and is out jogging every morning at 4:30 AM. He continues to challenge
himself by tracking his weight, his running times, and his blood pressure. His dedication and success have earned him
the title of Heart Star.
Coumadin continued. . .
clots might form in susceptible people. The best approach to this problem is to eat green leafy vegetables
and salads daily, steadily and consistently in order to
avoid variable effects of the Coumadin and to check
the prothrombin time/INR regularly.
Dorothy’s White Chili
3 chicken breasts (cut up)
1 tbsp. oregano
4 cans of Northern Beans
1 tbsp. cumin
7 c. chicken broth
2 tsp. chili powder
1 7oz. can of green chilies
Living Healthy
Exercise-A Healthy Addiction
Many individuals find themselves
addicted to exercise-with positive results. Years ago, scientists discovered a connection between endurance exercise and certain molecules
released in the brain called endorphins. These molecules are naturally produced and seem to raise the
body’s pain threshold and produce
feelings of euphoria. As little as a 20minute brisk walk will stimulate the brain to release
these endorphins, and produce a desirable, addictive
effect. If a few workouts are missed, you experience a
form of withdrawal. Exercise seems to be one healthy
addiction to latch onto.
Help Others by Making a Memorial Contribution
Patients frequently ask how a donation or contribution
can be made in the memory of a good friend or family
member lost to heart disease. Many people feel
money given to fund research and education is more
meaningful than flowers. To honor the memory of a
loved one, memorial contributions can be made to:
The Weatherhead PET Center for Prevention and
Reversal of Heart Disease
6431 Fannin Suite 4.256
Houston, TX 77030
Include the name and address of the person being
honored; an acknowledgement will be sent to the
family.
Available through
Rutgers University Press
100 Joyce Kilmer Ave.
Piscataway, NJ 08854
5 cloves garlic
1 tbsp. Worcestershire sauce
1 large chopped onion
16 oz. can chopped tomatoes
Salt and pepper to taste
1 tbsp Tabasco Sauce (optional)
Sauté onions, put the rest of the ingredients in pot
except chicken. Stir frequently for 20 minutes. Add
chicken and simmer another 40 min, covered.
Top each serving bowl with a dab of fat-free sour cream
and reduced fat tortilla strips.
Food Suggestions
Jones Dairy Farm Lean Choice
Sliced Canadian Style Bacon-3
slices/3 grams fat, 11 grams protein.
Good chopped up in egg white omelet or in place of ham or bacon in
recipes.
Blue Bunny Health Smart Frozen Ice
Cream Bars –non-fat, 1 gram of protein and 70 calories. Orange and Vanilla Swirl and Raspberry and Vanilla Swirl flavors.
Barry’s Bakery French Twists- sweet puffed pastryavailable at Central Market. Only 2 grams of fat per twist,
but be careful, hard to eat just one.
Gourmet Baker British Style toaster Muffins (Crumpets)
Fat Free, Cholesterol Free, 82 cal/serving 3 gms protein.
PET News is published twice annually for the patients
and friends of the Weatherhead PET Imaging Center
for the Prevention and Reversal of Heart Disease. We
welcome your story ideas, comments, and suggestions.
Mary P. Haynie R.N., MBA
Associate Editor, PET News
6431 Fannin, Suite 4.256
Houston, TX 77030
Or call: 800-446-9323
[email protected]